New Technology Makes Home Dialysis an Easier Option


CHICAGO — New hemodialysis technology is making it easier for more patients to receive this treatment at home, rather than using already burdened dialysis centers.

Although very few patients currently use in-home hemodialysis, those who have been able to take advantage of the newer systems prefer this option, according to Dr. Michael A. Kraus. “The patients' acceptance is huge,” he said at a meeting on clinical nephrology sponsored by the National Kidney Foundation.

Having dialysis at home offers many advantages, included improved quality of life, greater patient satisfaction, and lower costs than the traditional approach of three dialysis treatments per week given in a dialysis center.

In-center dialysis patients not only experience poor quality of life, but the treatment is very expensive. The centers must be staffed by nurses and technicians, and the cost of transporting patients to dialysis centers adds considerably to the overall expense.

Dr. Kraus, a nephrologist at Indiana University, Indianapolis, noted that because of in-center dialysis costs, 6.6% of the Medicare budget is spent for 0.1% of patients. In addition, the current shortage of dialysis nurses and technicians will only worsen as the dialysis population increases.

Although in-center dialysis leads to about 7 hours of postdialysis fatigue, inflexible schedules, and the need for drug regimens including multiple drugs, almost all patients rely on this method of dialysis. “Virtually no one does dialysis at home,” Dr. Kraus said.

New technology may offer more people the chance to have hemodialysis at home in the future, which can eliminate the cost of transportation and lower overall nursing costs, because patients rely on a family member to assist with the procedure.

Dr. Kraus explained how the newest in-home dialysis systems available differ from one another. The Aksys PHD (personal hemodialysis) System, the first system approved by the Food and Drug Administration for home dialysis, includes a sterilization mechanism that allows patients to reuse all the plastic elements for 1 week. This minimizes storage requirements. The more widely used system, the NxStage System One, uses sterile fluid that comes in bags, so patients do not need to supply additional water. This smaller system is portable, allowing users to travel. This newest system approved by the FDA includes a self-contained unit that generates enough dialysate for 2–3 days.

To evaluate the efficacy and utility of home dialysis, Dr. Kraus conducted a multicenter study of 32 patients who had hemodialysis at home 6 days/week for about 2.5 hours/session. Blood pressure readings declined, and the use of antihypertensive medication declined. Patients also reported increased satisfaction. “Our patients love the therapy,” said Dr. Kraus, who has conducted research on the NxStage System One and is an advisor to the company.

Although there are no recent studies comparing mortality of patients who use in-home vs. in-center dialysis, older studies did show a nonsignificant improvement in mortality, he said.

Dr. Kraus noted other benefits from home dialysis. “We see a marked improvement in blood pressure. Anemia tends to improve.” An NIH study of short daily in-home dialysis, compared with the standard method should shed more light on potential benefits.

In-home dialysis may also offer an economic benefit for society, Dr. Kraus noted. With the flexibility it provides and the improved quality of life, many end-stage renal disease patients are able to resume working. This could decrease government expenditures for end-stage renal disease patients. “If we can get patients back to work, we can get them off the Medicaid rolls.”

As in-home dialysis becomes more readily available, Dr. Kraus sees an important advantage: “In the future, it will be by far the cheapest treatment available,” he predicted.